Clinical Medicine Insights. Case Reports最新文献

Background: Morphea is a skin condition marked by erythematous and hardened inflammatory lesions that can progress to atrophic and sclerotic plaques. In this case report, we present a case of a pregnant woman who showed morphea presentation.

Case presentation: A 37-year-old G₂P₁L₁ woman with a gestational age of 32 weeks and 2 days was referred to the hospital with complaints of swelling, pain, and erythema in both legs for the past week, without any obstetric complaints. Upon initial examination at the time of admission, swelling, erythema, warmth in both legs, ecchymotic lesions, and non-pitting edema were observed. Biometry and color Doppler ultrasound for evaluation of fetus growth was normal. Skin examination revealed mild erythema, warmth, and purpura and petechiae in some areas, with an orange peel appearance and firm texture on palpation. Leg lesion skin punch biopsy reported a sclerodermoid reaction pattern and findings more compatible with morphea. The patient was managed for morphea during pregnancy. However, at 38 weeks and 6 days of gestation, due to worsening symptoms and spreading stiffness to the groin area, and the need for initiating pulse corticosteroids and mycophenolate mofetil (CellCept), the patient was re-admitted for cesarean section. In the follow-up assessment, ultrasound findings were normal, IGRA, HIV antibody, HCV antibody, HBC antigen, and HBS antigen were negative, and no edema or inflammation was seen in the patient.

Conclusions: In conclusion, although our patient recovered without specific treatment, predicting the recurrence or worsening of morphea in future pregnancies is challenging.

Introduction: Ewing sarcoma is a rare and highly aggressive malignancy, mostly involving the axial skeleton. Ewing sarcoma usually affects children and young adults under 20. Usually presenting as a painful swelling and discomfort worsening over time.

Case report: We present a case of a 19-year-old female with no known co-morbidities presenting in the Emergency Department with complaints of fever and backache for the past 2 weeks and bilateral lower limb weakness for more than a week. She was started on steroids and broad-spectrum antibiotics and packed cell volume due to low hemoglobin. The screening MRI of the cervical and dorsal spine without contrast revealed signal abnormalities in the vertebral bodies at multiple levels (C2, C5, C6, C7, T1, and T3), as well as within the spinous processes and interspinous musculature. Further evaluation with contrast-enhanced MRI was recommended. The contrast-enhanced MRI showed straightening of the cervical and dorsal spine due to muscular spasm. Additionally, there were small soft tissue components in the left paravertebral region at the level of D3, extending into the epidural space, and epidural components encasing the thecal sac at the levels of D5, D9, and D10 suggestive of neoplastic lesions, most likely metastasis. The morphological and immunohistochemical correlation established the diagnosis of Ewing Sarcoma of the left thigh with nodal, para-spinal, and soft tissue metastatic lesions.

Conclusion: Ewing Sarcoma is generally reported in the pediatric population and may come into clinical view based on a plethora of signs and symptoms. Appropriate imaging in the form of X-rays, CT scans, and MRI must be employed to correctly diagnose, and stage the condition.

Introduction: Intra-parotid metastasis refers to the spread of cancerous cells from a primary tumor to the lymph nodes within the parotid gland. To our best knowledge, we report the first described case in the literature of a patient who received IMRT for nasopharyngeal carcinoma (UCNT) without sparing the parotid gland and still experienced a recurrence.

Case presentation: A 57-year-old male patient of north African origin presented with a left parotid mass that had been evolving for 6 months. He was previously diagnosed with and treated for nasopharyngeal carcinoma 2 years prior to admission, with Intensity-Modulated Radiotherapy (IMRT) without sparing the parotid gland, as well as chemotherapy. Medical imaging was suggestive of recurrence of nasopharyngeal carcinoma and metastasis due to the patient's medical history. The patient benefited from a total parotidectomy; The histopathological analysis of the surgical specimen confirmed the presence of a poorly differentiated carcinoma (UCNT) with nodal metastasis.

Conclusion: Intensity-Modulated Radiation Therapy (IMRT) holds great promise as an alternative treatment option. However, it should be reserved for specific cases with minimal lymph node involvement, and always preceded by a thorough clinical and radiological examination.

Constrictive pericarditis can lead to compromised diastolic ventricular filling due to pericardial inflammation and fibrosis. A diagnosis of constrictive pericarditis was established by identifying structural and hemodynamic features through echocardiography. We present a case of constrictive pericarditis, which manifested in the form of gradually worsening dyspnea and lower-extremity edema over a 7 years period. The patient was diagnosed with constrictive pericarditis using echocardiography, and underwent a pericardiectomy.

Condyloma acuminata (CA) is a common manifestation of human papillomavirus (HPV) infection affecting the urogenital tract. While external genital lesions are frequently encountered, urethral involvement presents a therapeutic challenge due to the risk of recurrence and long-term complications such as urethral stricture. We present a case of urethral condyloma acuminata in a 43-year-old male patient who demonstrated favorable progression following electrocoagulation therapy. The patient presented with urethrorrhagia and lower urinary tract symptoms, with subsequent diagnosis confirmed via urological examination. Negative results from extensive microbiological testing supported the diagnosis. Treatment involved biopsy excision combined with electrocoagulation, resulting in complete resolution of symptoms without recurrence at 2-month follow-up. This case underscores the importance of individualized treatment strategies for intraurethral condyloma acuminata and highlights electrocoagulation therapy as a viable option with favorable outcomes.

Background: The giant cell tumor of the tendon pod is a benign neoplasia that can be present in any bone or tendon pod. Its etiology is unknown. Nevertheless, it is related to a chronic inflammatory process. It usually occurs in women between the third and fifth decade as a palpable and painless mass and slow growth, although it can be deformed and lead to limb loss.

Case presentation: In this report, we present the case of an 11-year-old male patient, which began on June 21, 2020, with a blunt trauma. An ultrasound was performed, reporting compatible data with synovial sarcoma. Magnetic resonance was requested, with mass evidence in soft tissues in central and planting portions. A surgical procedure with a split and biopsy of the mass was carried out. The specimen was sent to the Pathology Department, leading to a diagnosis of a giant cell tumor of the tendon pod.

Conclusions: The giant cell tumor of the tendon pod is rare. However, in some cases, it is crucial to consider it as a differential diagnosis. The surgical management of this entity has proven to reduce recurrence rates.

Diquat poisoning is a fatal condition that is becoming increasingly common. The mortality risk of patients taking lethal doses of diquat is extremely high. It typically leads to rapid dysfunction of multiple organs, including the kidneys, heart, lungs, and brain. Acute kidney injury is usually the first manifestation of this poisoning. However, the optimal treatment strategy for diquat poisoning remains uncertain. Additionally, the mechanism of multiple organ dysfunction syndrome caused by diquat poisoning may resemble the progression of sepsis. In this report, we present 3 cases of diquat poisoning, all of which resulted in death. We emphasize that acute kidney injury is the primary cause of death, and suggest that some strategies used in the treatment of sepsis could be beneficial in managing diquat poisoning-induced acute kidney injury.

The virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) causes COVID-19, a potentially fatal disease. The COVID-19 vaccine is indicated for active immunization to prevent COVID-19 caused by SARS-CoV-2. We reported the case of a 66-year-old woman with a medical history of hypertension and anxious-depressive syndrome who developed Guillain Barré Syndrome (GBS) 4 weeks after receiving the COVID-19 vaccine. During the patient's hospital stay, they received cycles of high-dose intravenous immunoglobulin (IVIG) and plasmapheresis treatments.. Despite the treatment, a deterioration of respiratory function led the patient to premature mortality.

Introduction: Cardiac hemangioma is one of the rarest tumors, with only a few cases described. Unlike other cardiac tumors, its symptoms are nonspecific, making misdiagnosis easy. Cardiac hemangioma can present with various clinical manifestations, including valve disorder, arrhythmia, pericardial effusion, and embolism. Echocardiography is the most direct examination, and surgical resection the simplest and most effective treatment.

Patients and methods: We present a new case of lobulated cardiac hemangioma causing tricuspid regurgitation and discuss the clinical features, diagnosis, and treatment of this rare tumor.

Results: After surgical resection and tricuspid valve replacement, the patient recovered well.

Conclusion: For cardiac hemangiomas involving the tricuspid valve, tumor resection combined with valve surgery is an effective treatment option.

Heart tumors are sporadic. Secondary heart tumors are 30 times more common than primary ones. Depending on the location and origin of the tumor, clinical pictures vary from asymptomatic to severe manifestations such as arrhythmia, heart failure, pericardial effusion, and cardiogenic shock. We report hereby a rare case who presented with faint clinical symptoms, rapidly progressing to right heart failure within a month. Echocardiography and computed tomography of the chest revealed a tumor in the right heart chamber of 72.0 × 43.0 mm, in addition to large mediastinal lymph and left supraclavicular lymph nodes, cardiogenic shock appeared 4 days after admission. Through examination, it was suspected that this was a cardiac lymphoma. The patient was treated with 2 mg methylprednisolone per kg body weight. Symptoms of cardiogenic shock improved significantly and disappeared after 6 hours of treatment. After supraclavicular lymph node biopsy and immunohistochemistry, the final result was diagnosed as diffuse large B-cell non-Hodgkin lymphoma with large lymphoma in the right heart. The patient received chemotherapy with the R-CHOP regimen (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone). Re-examination before the 5th chemotherapy cycle showed no signs of right heart failure, normal self-activity, and no dyspnea on exertion, and the tumor size in the heart on the echocardiogram was 23.8 × 19.1 mm. The report shows that a large right heart tumor with a clinical picture of cardiogenic shock in a patient with diffuse large B-cell non-Hodgkin's lymphoma was well-responded to initial treatment with methylprednisolone at a dose of 2 mg/kg body weight and R-CHOP chemotherapy.